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  • • Gastroschisis: Associated with other abnormalities 10% of time, most often intestinal atresia, associated with preterm infants

    • Omphalocele: Associated with other abnormalities 50% of time, nearly always full-term infants

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Epidemiology

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  • • Gastroschisis: 1/3000-1/8000 births

    • Omphalocele 1/6000-1/10,000 births

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Symptoms and Signs

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  • • Gastroschisis nearly always located to right of umbilicus, inflamed bowel and foreshortened mesentery secondary to exposure to amniotic fluid

    • Umbilical cord part of sac in omphalocele along with peritoneum

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Imaging Findings

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  • • Abdominal wall defect often noted with prenatal US

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  • • Associated congenital abnormalities, especially intestinal atresia with gastroschisis

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Rule Out

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  • • Intestinal atresia with gastroschisis

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  • • History and physical exam

    • Chest film

    • Echocardiogram (for omphalocele)

    • Renal US (for omphalocele)

    • CBC

    • Metabolic panel

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Surgery

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  • • Primary repair possible in 60-70%

    • Silastic pouch or silo construction followed by gradual reefing and eventual closure

    • Giant omphaloceles: Nonoperative initial therapy, gradual epithelialization, and closure months to years later

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Medications

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  • • Total parenteral nutrition during resolution of ileus

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Complications

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  • • Abdominal compartment syndrome

    • Necrotizing enterocolitis (15% in gastroschisis)

    • Delayed ileus or intestinal dysmotility (especially in gastroschisis)

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References

Lunzer H, Menardi G, Brezinka C: Long-term follow-up of children with prenatally diagnosed omphalocele and gastroschisis. J Matern Fetal Med 2001;10:385.  [PubMed: 11798448]
Molik KA et al: Gastroschisis: a plea for risk categorization. J Pediatr Surg 2001;36:51.  [PubMed: 11150437]
Sandler A, et al.: A Plastic sutureless abdominal wall closure in gastroschisis. J Pediatr Surg 2004;39:738.  [PubMed: 15137009]

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